1. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Pharmacology Math Chapter 33

2. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2 Drug Management The medical assistant must be absolutely certain that the medication prepared and administered to the patient is exactly what the physician ordered. Although drugs often are delivered by the pharmacy in unit dose packs, the dosage ordered may differ from the dose on hand. In this case the medical assistant must be prepared to calculate the correct dose accurately.

3. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 3 Dosages There is no margin of error in drug calculations. Even minor mistakes may result in serious complications. The MA must take meticulous care in calculating all drug dosages. If the dosage ordered by the physician is different from the dosage on hand, the MA must complete three basic steps.

4. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 4 Three Steps for Correct Dosage 1.Based on the type of system printed on the label, determine if the physician order is in the same mathematic system of measurement.  If the systems vary (the order is in teaspoons but the label states the medication is to be prepared in milliliters), then accurately convert the order to match the system on the label. 2.Perform the calculation in equation form, using the appropriate formula. 3.Check your answer for accuracy, and ask someone you trust to confirm your calculations.

5. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 5 Accurate Dose All three of these steps must be completed before the medication is dispensed and administered. Confirm your calculations with the physician if you have any doubt about their accuracy.

6. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 6 Accurate Dose (cont’d)

7. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 7 Drug Labels Accurately read the drug label to determine if the physician order and the packaged drug use the same system of measurement. Examples: – Physician orders 10 ml of a drug and the drug label states there are 20 ml/cc. – Physician orders 4 g of a drug and the medication label states there are 2 g/tab. – Physician orders 6 mg of a drug and the medication label reads there are 12 mg/scored tab.

8. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 8 Drug labels

9. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 9 Label Terms Strength: The potency of the drug. Stated as a percent of drug in the solution (2% epinephrine); as a solid weight (g, mg, lb, gr); or as a milliequivalent or unit. Dosage: The size or amount of medication in the drug unit. Could be in ml, tsp, or a number of tabs. For example, label reads “Imitrex, 6 mg/0.5 ml,” which means there are 6 mg of Imitrex in each 0.5 ml. Solute: Pure drug dissolved in a liquid to form a solution. Solvent (Diluent): The liquid, usually sterile water, that dissolves the solute.

10. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 10 Systems of Measurement Physician may order medication in a strength that is different than the one identified on the drug label. – Example: orders 2 gr of the drug but the label states there are 120 mg/tab Before determining how many tablets to administer, the MA must first convert the strength of the physician order to match the strength of the dose on the label since that is the medication that is available for administration. 3 different systems of measurement: metric, apothecary, and household.

11. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 11 Metric System Metric system of weights and measures is used throughout the world as the primary system for weight (mass), capacity (volume), and length (area). Based on units of 10 – Each larger unit of measure is 10 times the previous unit of measure. – Fractions are written as decimals (1½ L = 1.5 L). – Cubic centimeter = milliliter (1 cc holds 1 ml). – Amount or volume of a liquid medication is expressed in milliliters. – Weight or strength of a solid medication is expressed in grams.

12. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 12 Conversions to Smaller Units Units in the metric system are converted by moving the decimal point in multiples of 10. When going from larger to smaller units of measure, as in converting grams to milligrams, the answer will be a larger number, so move the decimal point to the right. – 0.35 g = 350 mg – OR multiply 0.35 g × 1000 = 350 mg

13. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 13 If converting smaller units of measurement to larger ones as in milliliters to liters, the answer will be a smaller number, so move the decimal point to the left. – 150 ml = 0.15 L – OR divide 150 ml by 1000 = 0.15 ml Conversions to Larger Units

14. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 14 Metric System Equivalents The following equivalents can be used to make conversions in the metric system. 1 kg = 1000 g 1 g = 1000 mg 1 mg = 0.001 g or 1/10,000 g 1 kl = 1000 liters 1 L = 1000 ml 1 ml = 0.0001 L or 1/1000 L

15. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 15 Apothecary System In the apothecary system the basic unit of weight for a solid medication is the grain (gr) and the basic unit of volume for a liquid medication is the minim (M). As in the metric system, these two units are related: the grain is based on the weight of a single grain of wheat, and the minim is the volume of water that weighs 1 gr.

16. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 16 System to System Equivalents 15 gr = 1 g = 1000 mg 5 gr = 0.3 g = 300 mg 1 quart = 1000 cc 1 fl oz = 30 ml 1 fl dr = 4 ml 15 M = 1 ml 1 M = 0.06 ml

17. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 17 Household Measurements The household system is used in most U.S. households. Although this system of measurement is important for the patient at home who has no knowledge of the metric or apothecary systems, it is not completely accurate. The household system should never be used in the medical setting. The basic measure of weight is the pound (lb) and of volume is the drop (gtt). – 1 gtt = 1 M – 60 gtt = 1 tsp – 3 tsp = 1 Tbsp (tablespoon) – 2 Tbsp = 1 oz – 8 oz = 1 cup

18. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 18 Conversions between Systems Formula: Drug Have × Wanted = Unit wanted in new system Have Drug Have—unit of measure that is on label (1 g/tab) Wanted—amount or strength ordered by physician Have—conversion (15 gr = 1 g) Order: Administer 30 gr of Lasix Label: 1 g Lasix/tab 1 g × 30 gr = 2 g = 2 tabs 15 gr

19. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 19 Calculating Drug Dosages for Administration Based on the strength of the drug and the amount as stated on the label – Example: 15 mg/tab means that each tablet in the bottle contains 15 mg of the drug, OR 250 mg/cc means that for each cc in the vial there is 250 mg of the drug. – Standard Formula Available Strength = Available Amount Ordered Strength Amount to Give

20. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 20 Pediatric Doses and Fried's Law Most important factor in determining the amount of a drug that should be administered to children is the weight of the child. Even a minor miscalculation may be dangerous. This calculation is for children younger than 1 year and is based on the age of the child in months compared with a child 12½ years old. Pediatric dose = Child's age in months  Adult dose 150 months

21. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 21 Young's Rule Young's rule is for children older than 1 year Pediatric dose = _Child's age in years__  Adult dose Child's age in years + 12

22. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 22 Clark's Rule This rule is based on the weight of the child. This system is much more accurate, because children of any age can vary greatly in size and body weight. Pediatric dose = Child's weight in pounds  Adult dose 150 pounds

23. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 23 West's Nomogram West's nomogram uses a calculation of the body surface area of infants and young children to determine the pediatric dose. Pediatric dose = BSA of child in m 2 × Adult dose 1.7 m 2 (Average adult BSA = 1.7 m 2.)

24. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 24 West’s Nomogram

25. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 25 Reconstitution Reconstituting powdered injectables requires adding an amount of solvent (as recommended on the drug label) to a vial of powdered or crystal medication. Once the solute and solvent are mixed in the vial, a solution of medication is formed with a strength based on equivalents printed on the drug label. Once the medication is mixed, carefully read the label to determine how much of the drug must be withdrawn to equal the physician’s order. Use the standard conversion formula to determine the accurate dose for administration.